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Adenosine-diphosphate (ADP) receptor antagonists for the prevention of cardiovascular disease in patients with type 2 diabetes mellitus

Valentine N, Van de Laar FA, van Driel ML
Published Online: 
14 November 2012

Patients with type 2 diabetes have a much higher risk of strokes and heart attacks than the general population. Most strokes and heart attacks are caused by blood clots. Adenosine-diphosphate (ADP) receptor antagonists are drugs which prevent the aggregation ('clumping') of platelets and consequently reduce the formation of blood clots. These medications are used to prevent cardiovascular disease such as heart attacks and strokes in the general population. This review assessed if these medications would be useful in patients with diabetes. We included eight trials with 21,379 patients and a mean duration of follow-up ranging from 365 to 913 days. Specific data for patients with diabetes were only available in full for one of these trials and partial data were available for two trials. Analysis of the available data demonstrated that adenosine-diphosphate receptor antagonists (such as clopidogrel, prasugrel, ticagrelor, ticlopidine) were not more effective than other blood thinning drugs or placebo for death from any cause, death related to cardiovascular disease, heart attacks or strokes. There was no available information on the effects of adenosine-diphosphate receptor antagonists on health-related quality of life, adverse effects specially for people with diabetes, or costs. The use of adenosine-diphosphate receptor antagonists in patients with diabetes needs to be guided by the information available from trials which included patients with and without diabetes. All future trials on adenosine-diphosphate receptor antagonists should include data which relate specifically to patients with diabetes in order to inform evidence-based clinical guidelines.

This record should be cited as: 
Valentine N, Van de Laar FA, van Driel ML. Adenosine-diphosphate (ADP) receptor antagonists for the prevention of cardiovascular disease in type 2 diabetes mellitus. Cochrane Database of Systematic Reviews 2012, Issue 11. Art. No.: CD005449. DOI: 10.1002/14651858.CD005449.pub2
Assessed as up to date: 
31 May 2011